35 eggs retrieved age 39=PCOS?
4 Replies
jenisci - September 15

Dear Dr Jacobs,

I am 39 years old and am undergoing IVF with ICSI for male infertility (low motility/morph). My day 3 FSH is 5.6, did not test for LH, but all other day 3 tests (E2 35-49, prolactin-6, random glucose-88) normal. I have regular cycles of 28-30 days- were 28 on the nose til I started TTC. In the past year of tracking my cycles I have a clear ovulatory pattern, get a positive on LH strips at appropriate time, and seem to ovulate every month without fail (confirmed once by progesterone test in luteal phase)

I have never been diagnosed with PCOS. I am overweight and have always struggled with my weight, despite eating a very healthy diet in moderation. My mother and grandmother have also had weight issues and need to eat low calories to maintain an overweight but healthy frame. However I am very hourglass-shaped (busty and hippy with smaller waist), rather than apple shaped. I have very little body hair- it is thin and blonde. I do get one freak hair that grows on my neck under my chin on occassion, but that's it. I have always been very careful with birth control before TTC, but did have one unlikely accidentally pregnancy in my mid-twenties after using the withdrawal method literally once (different partner). So I have always assume I was hyper-fertile.

On CD2 my ovaries had the string of pearls appearance and the RE said I had over 20 follicles, she saw at least 12 on my right ovary and couldn't see my left as well but that it looked the same. They looked like a ring of follicles around the outer edge with nothing in the middle. On previous natural cycles midcycle I have had one clearly dominant normal large follicle plus around 14 medium-smaller ones, that at that point in my cycle I saw some follicles in the middle.

I stimmed at 300 gonal-f/75 menopur for the first three days, then shifted down to 225 gonal-f/75 menopur, stimming for a total of 10 days. On stim day 6 my E2 was 1602, and on the day of the trigger shot it was 4,585. I still have a lot of abdominal discomfort but have gained less than 5 lbs over the cycle. I did acupuncture weekly during stims.

On my last sono before retrieval I was told I had 12 follicles in each ovary, but to only expect around 15 mature at retrieval. I was given 1/2 a trigger shot (5,000 HCG) due to risk of OHSS. At the time the RE said my ovaries were between the size of an orange and a grapefruit each.

At my retrieval, they got 35 eggs. Of these, only 10 were mature. 8 were semi-mature. 16 were immature, one was dead. Out of this I got 12 fertilized (originally 14 but 2 died within 24 hours) with ICSI and alive by day 3, though 2pn was only seen in 6 the next day. Most of these embryos seem to be very slow developers. I have 2 grade 1, one 8 cell one 7 cell, 4 grade 2, two 7-cell and two 4-cell, and 6 grade 3 (worst), 1 5 cell, 3 4 cell and 2 2-cell.

I have read that slow-developing and immature eggs along with retrieving 30-50 eggs during IVF can mean PCOS. Is it likely that I have PCOS? Or am I likely normal and just have an unusually large amount of eggs for my age (and we didn't get my stim protocol quite right this time or needed to sacrifice mature eggs due to OHSS risk)? I wondering if I should go back to my gyno if this IVF fails (or after pregnancy if it works) to be checked out for PCOS. I hear this has health complications beyond fertility if you have it.

From a fertility perspective, I am wondering if having this many eggs at my age in a good thing and just needs the right protocol, or if it is a problem.

Thanks!

Jen

 

B. Jacobs, M. D. - September 15

Please understand that I cannot make a diagnosis on the basis of information received on line. I need to personally evaluate someone. Also, at the age of 39, your eggs are less likely to be as good as they were at the age of 29. There is a greater probabability that they will have the wrong number of chromosomes. Finally, if you have polycystic ovaries, egg quallity is likely to be somewhat impaired. It is not likely that your OB can provide the benefit of achieving a pregnancy. As long as you desire to achieve a pregnancy, remain in the care of a Reproductive Endocrinologist.
Good luck.

 

jenisci - September 15

Thank you for your response Dr Jacobs.

I absolutely plan on staying in the care of my RE to attain pregnancy, I just wondered if I should consult my OBGYN to be checked out for PCOS for health reasons/treatment. Or if having signs of PC ovaries in the absence of other obvious symptoms does not mean PCOS and I shouldn't bother. I also wondered if the slow dividing problem was likley due to PCO type ovaries or not getting the med protocol quite right the first time and triggering prematurely/stimming too fast, and it sounds you are saying it may be due to having PCO type ovaries.

 

B. Jacobs, M. D. - September 16

Part of the training and experience of an RE is diagnosis and treatment of polycystic ovaries. Actually, an RE is probably better equiped to do so than most OB's.
Good luck.

 

jenisci - September 20

Thanks Dr. Jacobs! I will ask her the next time I see her. I did end up transferring 3 early blasts (grades 1 and 2) on day 5 with one grade 2 blast to freeze on day 6, so hopefully this will work and I won't need to worry about switching the protocol.

 

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